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COMMITTEE OF EXPERTS ON THE CLASSIFICATION OF MEDICINES AS REGARDS THEIR SUPPLY (CD-P-PH/PHO) Report classification/justification of medicines belonging to the ATC group D07A (Corticosteroids, Plain) Table of Contents Page INTRODUCTION 4 DISCLAIMER 6 GLOSSARY OF TERMS USED IN THIS DOCUMENT 7 ACTIVE SUBSTANCES Methylprednisolone (ATC: D07AA01) 8 Hydrocortisone (ATC: D07AA02) 9 Prednisolone (ATC: D07AA03) 11 Clobetasone (ATC: D07AB01) 13 Hydrocortisone butyrate (ATC: D07AB02) 16 Flumetasone (ATC: D07AB03) 18 Fluocortin (ATC: D07AB04) 21 Fluperolone (ATC: D07AB05) 22 Fluorometholone (ATC: D07AB06) 23 Fluprednidene (ATC: D07AB07) 24 Desonide (ATC: D07AB08) 25 Triamcinolone (ATC: D07AB09) 27 Alclometasone (ATC: D07AB10) 29 Hydrocortisone buteprate (ATC: D07AB11) 31 Dexamethasone (ATC: D07AB19) 32 Clocortolone (ATC: D07AB21) 34 Combinations of Corticosteroids (ATC: D07AB30) 35 Betamethasone (ATC: D07AC01) 36 Fluclorolone (ATC: D07AC02) 39 Desoximetasone (ATC: D07AC03) 40 Fluocinolone Acetonide (ATC: D07AC04) 43 Fluocortolone (ATC: D07AC05) 46 2 Diflucortolone (ATC: D07AC06) 47 Fludroxycortide (ATC: D07AC07) 50 Fluocinonide (ATC: D07AC08) 51 Budesonide (ATC: D07AC09) 54 Diflorasone (ATC: D07AC10) 55 Amcinonide (ATC: D07AC11) 56 Halometasone (ATC: D07AC12) 57 Mometasone (ATC: D07AC13) 58 Methylprednisolone Aceponate (ATC: D07AC14) 62 Beclometasone (ATC: D07AC15) 65 Hydrocortisone Aceponate (ATC: D07AC16) 68 Fluticasone (ATC: D07AC17) 69 Prednicarbate (ATC: D07AC18) 73 Difluprednate (ATC: D07AC19) 76 Ulobetasol (ATC: D07AC21) 77 Clobetasol (ATC: D07AD01) 78 Halcinonide (ATC: D07AD02) 81 LIST OF AUTHORS 82 3 INTRODUCTION The availability of medicines with or without a medical prescription has implications on patient safety, accessibility of medicines to patients and responsible management of healthcare expenditure. The decision on prescription status and related supply conditions is a core competency of national health authorities. The conditions of the supply of medicines vary considerably in Council of Europe member states, due to the fact that the provisions are differently interpreted and implemented by the member states, and that important additional classification criteria are not harmonised. The Committee of Experts on the Classification of Medicines as regards their Supply (CD-P- PH/PHO)1 is co-ordinated by the European Directorate for the Quality of Medicines and HealthCare (EDQM, Council of Europe) and its working programme is based on Committee of Ministers Resolution CM/Res(2018)1 on the classification of medicines as regards their supply2. In its work, the CD-P-PH/PHO focuses on public health promotion and uses scientific approaches, taking account of the national assessments of direct and indirect risks which may occur under normal treatment conditions and under medical surveillance, as well as from foreseeable misuse or abuse of medicines. The CD-P-PH/PHO issues twice a year recommendations to health authorities of Council of Europe member states (EU and non-EU member states) on the classification of medicines and establishes good classification practices. The recommendations are also useful for pharmaceutical manufacturers and commercial operators of mail-order trade in medicines where such trade is legal. A pioneer in this field, Council of Europe bodies have been concerned since 1961 with issues relating to the classification of medicines into prescription and non-prescription medicines and have inspired relevant EU legislation. The classification criteria set out in the Council of Europe resolutions have been supplanted by Directives 92/26/CEE and 2001/83/EC (art. 70-75). Directive 2001/83/EC refers to the Council of Europe in its Whereas 32: “It is therefore appropriate, as an initial step, to harmonise the basic principles applicable to the classification for the supply of medicinal products in the Community or in the Member State concerned, while taking as a starting point the principles already established on this subject by the Council of Europe”3. It is important to note that: - The CD-P-PH/PHO does not issue recommendations on the classification of particular medicines, but on active substances used in a medicine for a specific therapeutic purpose. - In its work, the CD-P-PH/PHO uses the Anatomical Therapeutic Chemical (ATC) classification maintained by the WHO Collaborating Centre for Drug Statistics Methodology4 to identify active substances or combinations of active substances. - The CD-P-PH/PHO does not give advice relating to pending marketing authorisation procedures. The CD-P-PH/PHO supervises a database (i.e. Melclass5), hosted by the EDQM, which stores the recommendations that the Committee of Experts issues twice a year to health authorities of the 1 http://go.edqm.eu/PHO 2 http://go.edqm.eu/CMRes20181 3 https://goo.gl/at4RZo 4 https://goo.gl/KvqKir 5 https://melclass.edqm.eu/ 4 Council of Europe member states which are parties to the Convention on the Elaboration of a European Pharmacopoeia, as well as national information about the classification status and supply conditions of medicines in these member states. The information is publicly available. Recommendations about 2100 medicines are published in the Melclass database. Providing a platform for dialogue and consensus building on the supply conditions of medicines in Europe as facilitated by Council of Europe Committee of Ministers Resolution CM/Res(2018)1, the CD-P-PH/PHO promotes patient safety and, where appropriate, access to medicines without a prescription across Europe, which helps to foster public health and to responsibly manage healthcare resources. 5 DISCLAIMER This document is published for information only. The reports included in this document have no legal status and no binding character. They reflect the debates and conclusions of the reviews of scientific classifications of medicines that took place at the 2019 bi-annual meetings of the CD-P-PH/PHO. The document was reviewed and endorsed by the CD-P-PH/PHO at its 67th meeting (December 2019). The reviews carried out do not commit the parent authorities of the experts nor the Council of Europe/EDQM. 6 GLOSSARY OF TERMS USED IN THIS DOCUMENT ACTH Adrenocorticotropic hormone ATC Anatomical Therapeutic Chemical classification 1 CSC Central serous chorioretinopathy EDQM European Directorate for the Quality of Medicines and HealthCare EMA European Medicines Agency GSL General sales list medication HPA Hypothalamic-pituitary-adrenal MDD Maximal daily dose MQP Maximal quantity per pack MS Maximal strength P Pharmacy-only medication POM Prescription only medicine SmPC Summary of product characteristics WHO World Health Organization Classification used throughout this document Following the stipulations of Resolution CM/Res(2018)1, the lists of active substances classified according to the conditions of supply of the medicines which contain them are drawn up with reference to all the risks, direct or indirect, which they may represent to human health whether they are used in accordance with the product information leaflet or not. The differentiation into two prescription lists (List I and List II) applies only to the countries which classify prescription medicines into two categories based on whether the prescription can be renewed or not. 1. Active substances in medicines subject to prescription List I: the supply of a medicine containing one of the substances in this list should not be renewed without the prescriber having so specified. This classification should apply to active substances of medicines indicated for conditions calling for short-term treatment and/or for which continuous medical supervision is necessary, either because of potential undesirable effects or to check the efficacy of treatment; or active substances of medicines administered for diagnostic purposes; or active substances with a new pharmacological mechanism of action. List II: the supply of a medicine containing one of the substances in this list can be renewed. This classification should apply to active substances in medicines indicated for conditions for which the patient may continue the regular or intermittent treatment without new medical advice, and for which well-known undesirable effects do not call for frequent clinical examination. Exemptions from Lists I and II under certain circumstances: depending on the conditions of use of the medicine, active substances contained in prescription medicines may also be contained in medicines classified under the same ATC code but which are not subject to prescription. Under certain circumstances, exemptions from the prescription requirement may be set out in the Melclass database: - in respect of a low dosage or concentration of the active substances and/or the therapeutic indications of medicines in which they are contained; - according to the route of administration and the composition of the medicine; - according to the total amount of the medicine per container. 2. List of active substances in medicines not subject to prescription: active substances in medicines which are not classified as subject to prescription in Lists I or II. 1 World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology - https://goo.gl/KvqKir 7 1. THERAPEUTIC PROFILE 1.1 Active ingredient: Methylprednisolone 1.2 ATC code: D07AA01 1.3 Therapeutic indications: treatment of various skin disorders, such as atopic dermatitis, allergic eczema. 1.4 Posology and duration of treatment: - 1.5 Pharmaceutical forms: - 1.6 Contraindications: - 1.7 Relevant warnings:
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